Upper limb motor and sensory impairments in children with hemiplegic cerebral palsy. Can they be measured reliably?

Klingels, Katrijn; Cock, Paul De; Molenaers, Guy; Desloovere, Kaat; Huenaerts, Catherine; Jaspers, Ellen; Feys, Hilde

doi:10.3109/09638280903171469

Cited by 129 publications

(150 citation statements)

References 27 publications

(52 reference statements)

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“…17 Children were assessed by three physiotherapists routinely involved in the clinical evaluation of children with CP. Each MRI was scored using the sqMRI scale 13,15 by one paediatric neurologist (EO) who was blinded to the clinical outcome.…”

Section: Methodsmentioning

confidence: 99%

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How does the interaction of presumed timing, location and extent of the underlying brain lesion relate to upper limb function in children with unilateral cerebral palsy?

Mailleux

Klingels

Fiori

et al. 2017

European Journal of Paediatric Neurology

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Background: Upper limb (UL) function in children with unilateral cerebral palsy (CP) may vary largely depending on presumed timing, location and extent of brain lesions. These factors might exhibit a complex interaction and the combined prognostic value warrants further investigation. This study aimed to map lesion location and extent and assess whether these differ according to presumed lesion timing and to determine the impact of structural brain damage on UL function within different lesion timing groups. Materials and methods:Seventy-three children with unilateral CP (mean age 10 years 2 months) were classified according to lesion timing: malformations (N=2), periventricular white matter (PWM, N=42) and cortical and deep grey matter (CDGM, N=29) lesions.Neuroanatomical damage was scored using a semi-quantitative MRI scale. UL function was assessed at the level of body function and activity level.Results: CDGM lesions were more pronounced compared to PWM lesions (p=0.0003).Neuroanatomical scores were correlated with a higher degree to UL function in the CDGM group (r s =-0.39 to r s =-0.84) compared to the PWM group (r rb =-0.42 to r s =-0.61). Regression analysis found lesion location and extent to explain 75% and 65% (p<0.02) respectively, of the variance in AHA performance in the CDGM group, but only 24% and 12% (p<0.03) in the PWM group. Conclusions:In the CDGM group, lesion location and extent seems to impact more on UL function compared to the PWM group. In children with PWM lesions, other factors like cortical reorganization and structural connectivity may play an additional role.

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Section: Methodsmentioning

confidence: 99%

“…Stereognosis was assessed by tactile identification of six objects. For more details see Klingels et al 17 Interrater and testretest reliability of this protocol has been established.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

How does the interaction of presumed timing, location and extent of the underlying brain lesion relate to upper limb function in children with unilateral cerebral palsy?

Mailleux

Klingels

Fiori

et al. 2017

European Journal of Paediatric Neurology

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“…15 Muscle tone was scored with the Modified Ashworth Scale at the forearm (pronators; range 0-4) and wrist (wrist/finger flexors; range 0-8). Muscle strength was evaluated according to the Medical Research Council rating at the forearm (supinators/pronators; range 0-10) and wrist (flexors/extensors; range 0-10).…”

Section: Body Function Levelmentioning

confidence: 99%

Do mirror movements relate to hand function and timing of the brain lesion in children with unilateral cerebral palsy?

Klingels

Jaspers

Staudt

et al. 2015

Develop Med Child Neuro

121

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AIM This study aimed to systematically map the severity of mirror movements in both hands in a prospective cohort of children with unilateral cerebral palsy, and to explore the relationship with hand function and brain lesion type.METHOD Seventy-eight children were included (41 males, 37 females; age 9y 4mo, SD 3y 1mo, range 5-15y). Mirror movements were scored during three repetitive tasks following Woods and Teuber criteria. Strength, tone, Melbourne Assessment, Jebsen-Taylor test, and Assisting Hand Assessment were evaluated. Lesions were classified into malformations (n=5), periventricular (n=43), cortico-subcortical (n=22), and postnatally acquired lesions (n=8).RESULTS Significantly more mirror movements were observed in the non-paretic versus the paretic hand (p≤0.003). Higher mirror movement scores in the non-paretic hand significantly correlated with lower distal strength and lower scores on unimanual and bimanual assessments (r=0.29-0.41). In the paretic hand, significant differences were found between lesion types (p=0.03). INTERPRETATIONThe occurrence of mirror movements in the non-paretic hand seems related to hand function while mirror movements in the paretic hand seem more related to the lesion timing, whereby children with earlier lesions present with more mirror movements.Children with unilateral cerebral palsy (CP) often experience difficulties in bimanual coordination which affects daily life activities. Apart from spasticity, muscle weakness, and sensory deficits the occurrence of mirror movements has also been suggested as a possible contributing factor that interferes with bimanual performance. 1 Mirror movements are described as 'involuntary movements of one body part that mirror the voluntary movement of the contralateral homologous body part'.2,3 They are mainly observed in the upper limbs, are symmetrical by nature, and their intensity increases with increasing task complexity or fatigue. 4,5 Physiological mirror movements are present in newborn infants, show a steep decrease between 5 years and 8 years of age, and disappear after 10 years of age. 4,6 These mirror movements are most likely to be caused by incomplete maturation of the corpus callosum and concurrent less effective interhemispheric inhibition. Unilateral tasks thereby invoke activation of bilateral motor cortices. [6][7][8] Further maturation of the transcallosal pathways with age ensures increasing inhibition of the motor cortex ipsilateral to the task hand, thus reducing the occurrence of mirror movements. 7Mirror movements have frequently been described in unilateral CP, 3,8,9 mostly in the non-paretic hand, albeit with large variability. 1,3,[8][9][10] The pathogenesis for their occurrence is not yet fully understood. One potential hypothesis could be the activation of bilateral primary motor cortices due to deficient interhemispheric inhibition caused by the underlying brain lesion. 2,6 Conversely, the persistence of ipsilateral corticospinal projections between the non-lesioned motor cortex and the paretic hand has ...

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“…All assessments were performed by one trained physiotherapist, at the clinical motion analysis laboratory (University Hospital Pellenberg, Belgium), using a standardized protocol for the UL-3DMA [6,7] and the clinical evaluation [14].…”

Section: Data Collectionmentioning

confidence: 99%

The Arm Profile Score: A new summary index to assess upper limb movement pathology

et al. 2011

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Although three-dimensional movement analysis is being increasingly used to evaluate upper limb (UL) movements, information on how to interpret the complex data is still missing. This paper introduces a new summary index, the "Arm Profile Score" (APS), to evaluate the severity of UL movement pathology based on kinematic data, similar to the "Gait Profile Score". The APS is calculated from the root mean square (RMS) difference between kinematic data of the individual child with UL movement deficits and average data from typically developing children. The APS can be decomposed into 13 Arm Variable Scores (AVS), representing the different joint angles. The APS, together with the AVSs form the "Arm Movement Analysis Profile" (A-MAP). Face and construct validity were established for eight UL tasks in a group of 20 children with hemiplegic cerebral palsy (HCP). Intra-session variability was low for the different tasks, with median inter-quartile ranges below 2°. Correlation analysis showed few significant correlations between the individual AVSs and between the AVS and APS, implying that the A-MAP provides considerably more information compared to the APS only. The APS also showed good correlations with the House classification, and with measures of muscle tone, manual muscle strength and grip strength. This study provides a sound base to use the APS to evaluate UL movement pathology in children with HCP. Further study will need to confirm its value as an outcome measurement.

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Upper limb motor and sensory impairments in children with hemiplegic cerebral palsy. Can they be measured reliably?

Cited by 129 publications

References 27 publications

How does the interaction of presumed timing, location and extent of the underlying brain lesion relate to upper limb function in children with unilateral cerebral palsy?

How does the interaction of presumed timing, location and extent of the underlying brain lesion relate to upper limb function in children with unilateral cerebral palsy?

Do mirror movements relate to hand function and timing of the brain lesion in children with unilateral cerebral palsy?

The Arm Profile Score: A new summary index to assess upper limb movement pathology

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